Conventional Laparoendoscopic Single-site Surgery Research Articles

2835 Robot-Assisted Laparoendoscopic Single-Site (Ra-Less) Myomectomy Using Lapsingle Port

Study Objective To report our experience with robot-assisted laparoendoscopic single-site (RA-LESS) myomectomy using Lapsingle access, including outcomes & feasibility of this procedure. Design A Retrospective cohort study, from April 2018 to March 2019. Setting Single surgeon, Single medical center, University hospital. Patients or Participants Twenty-five patients with symptomatic subserosal or intramural myomas Interventions RA-LESS myomectomy was performed with the da Vinci Xi Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA, USA) employing 8 mm endoscope and single-site 5 mm instrumentation through a laparoendoscopic single-site (LESS) port (Lapsingle, Sejong Medical, KOREA). Measurements and Main Results The mean age (±SD) and mean BMI were 40.2 ± 7.2 years and and 22.5 ± 2.7 kg/m2. Mean diameter of the largest tumor was 6.8 ± 1.5 cm (median 6.1 cm, range 3.1-9.7 cm), while mean number of tumors removed was 2.2 ± 1.8, ranging from 1 to 5 per surgery. The mean operating time, hemoglobin change, return of bowel activity, and length of hospital stay were 95.2±43.2 min, 1.5±0.7 g/dL, 36.8±9.1 h, and 3.8±0.7 days, respectively. All procedures were successfully performed without conversion to conventional LESS surgery, multi-port laparoscopy or laparotomy. There were no surgical or wound complications in any patient, and the histopathological result was leiomyoma in all the cases Conclusion RA-LESS myomectomy is a safe and feasible surgery with excellent cosmetic and postoperative outcomes in selected patients. Further investigation is needed to define the patient groups that will most benefit from it.

Single-Incision Hysterectomy Outcomes With and Without Robotic Assistance

Objective:To evaluate the differences in operative time and postoperative complications for total laparoscopic hysterectomy (TLH) performed using conventional laparoendoscopic single-site surgery (LESS) versus a robotic-assisted LESS approach.Methods:A retrospective study was conducted of all cases of conventional LESS TLH (n = 47) and robotic LESS TLH (n = 129) for benign gynecologic conditions performed from November 2014 to October 2017. Patient characteristics, operative time for hysterectomy, estimated blood loss, duration of hospitalization, and short-term postoperative complications were compared using appropriate parametric and nonparametric statistical tests.Results:Conventional LESS TLH cases had a 16.36-minute longer mean operative time for hysterectomy (P < .01). No difference was found in uterine weight, estimated blood loss, hospitalization, or incidence of postoperative complications when LESS TLH was performed with or without robotic assistance. When comparing uterine weight < 100 g, conventional LESS TLH cases had significantly greater operative time than the robotic LESS TLH cases (78.10 ± 23.97 minutes vs. 59.97 ± 35.17 minutes, P < .01). When comparing uterine weight > 100 g, conventional LESS TLH cases again had significantly greater operative time than the robotic LESS TLH cases (98.73 ± 50.16 minutes vs. 80.00 ± 42.97 minutes, P < .01). There was no difference in postoperative complications.Conclusion:Robotic single-incision laparoscopy can result in decreased operative time compared to a conventional LESS approach. Robotic-assisted and conventional LESS are similar in rate of postoperative complications, if performed by surgeons with abundant LESS experience.

Coaxial robot-assisted laparoendoscopic single-site myomectomy.

We report our experience with coaxial robot-assisted laparoendoscopic single-site (RA-LESS) myomectomy, including a detailed description of the technique and outcomes from our first 21 cases. This was a retrospective cohort study carried out at the reproductive endocrinology and gynecologic oncology divisions at two academic medical centers. RA-LESS myomectomy was performed with the da Vinci Si Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA, USA) employing standard rigid 8 or 5mm instrumentation in a coaxial arrangement through a standard laparoendoscopic single-site (LESS) port (GelPOINT Advanced Access Platform, Applied Medical, Rancho Santa Margarita, CA, USA). Cases were completed between October 2011 and November 2013. Twenty-one patients underwent surgery. Mean age (±SD) was 38.1±5.8years, and mean BMI was 29.4±4.7kg/m2. Menorrhagia, pelvic pressure, and urinary frequency were the main presenting symptoms. Mean diameter of the largest tumor was 5.7±1.9cm (median 5.9cm, range 2.1-9.5cm), while mean number of tumors removed was 2.2±1.8, ranging from 1 to 8 per surgery. Mean operative time was 154.2±55.2min (median 152min, range 85-290min). Mean blood loss was 57.9±53.7cc (median 50cc, range 5-200cc) and length of hospital stay ranged between 0 and 3days (median 0). All procedures were successfully performed without conversion to conventional LESS surgery, multi-port laparoscopy or laparotomy. RA-LESS myomectomy with coaxial use of standard rigid instrumentation is a safe and reproducible addition to the minimally invasive surgeons' armamentarium, with excellent cosmetic and postoperative outcomes in selected patients. Further investigation is needed to define the patient groups that will most benefit from it.

Robotic single port surgery: Current status and future considerations.

Introduction and Objectives:It has been established that robotic-assisted laparoscopic surgery has several advantages when compared with standard laparoscopic surgery. Optics, ergonomics, dexterity and precision are all enhanced with the use of a robotic platform. For these reasons, it was postulated that the application of robotics to laparoendoscopic single-site surgery (LESS) could overcome some of the constraints seen with the conventional laparoscopic approach. Issues such as instrument clashing, inability to achieve effective triangulation for dissection and difficulties with intracorporeal suturing have limited the widespread adoption of conventional LESS. The application of robotics has eliminated many of the constraints experienced with conventional LESS; however, challenges still remain.Materials and Methods:A systematic literature review was performed using PubMed to identify relevant studies. There were no time restrictions applied to the search, but only studies in English were included. We used the following search terms: Robotic single site surgery, robotic single port surgery, robotic single incision surgery and robotic laparoendoscopic single site surgery.Results:A number of centers have published their experience with robotic-laparoendoscopic single-site surgery (R-LESS); however, no prospective studies exist. What is clear is that R-LESS minimizes several of the difficulties experienced with conventional LESS, including intracorporeal suturing and triangulation during dissection. Outcomes are comparable to standard robotic surgery, with a trend toward improved cosmesis and reduced pain. However, a significant advantage with regard to these two factors has yet to be demonstrated.Conclusions:R-LESS is technically feasible and the benefits of robotic surgery eliminate many of the challenges seen with conventional LESS. However, despite the advantages of the robotic platform, R-LESS is not free of challenges. Instrument clashing remains an issue due to the bulky profile of the current robotic system. Other issues include lack of space for the assistant at the bedside, inability to incorporate the 4th robotic arm for retraction and difficulties with triangulation. Although solutions for some of these issues are currently under development, R-LESS is still very much in its infancy.

Laparoendoscopic Single-Site Urethrovesical Anastomosis Training in an Economical Porcine Model

Purpose: To develop an economical animal model for laparoendoscopic single-site surgery (LESS) urethrovesical anastomosis (UVA) training. Materials and Methods: A homemade single-port device was used and the uterus cervix and the ileum were chosen to simulate UVA to reduce costs. Ten trainees were randomly divided into two groups: the conventional LESS UVA (CLUVA) group and the transurethral assistant LESS UVA (TALUVA) group. In TALUVA, a laparoscopic forceps was inserted through the urethra to assist operation after the bladder neck was disconnected, whereas CLUVA followed the conventional steps. Anastomosis time and knotting time were recorded, and the learning curves of both groups were analyzed. After training, questionnaires were given to the trainees to assess the difficulties and the satisfaction of the training. Results: The final mean operating time significantly declined in both groups. Except for the first lesson, the trainees in the TALUVA group operated faster than those in the other group. The results from the questionnaires show that all trainees were satisfied with the training, and LESS UVA was considered more difficult in the CLUVA group than in the TALUVA group. Conclusions: The female porcine model for LESS UVA was feasible and cost-effective. TALVUA could effectively reduce the difficulties involved in LESS UVA.

Comparison Between Magnetic Anchoring and Guidance System Camera-Assisted Laparoendoscopic Single-Site Surgery Nephrectomy and Conventional Laparoendoscopic Single-Site Surgery Nephrectomy in a Porcine Model: Focus on Ergonomics and Workload Profiles

To compare surgeon-assessed ergonomic and workload demands of magnetic anchoring and guidance system (MAGS) laparoendoscopic single-site surgery (LESS) nephrectomy with conventional LESS nephrectomy in a porcine model. Participants included two expert and five novice surgeons who each performed bilateral LESS nephrectomy in two nonsurvival animals using either the MAGS camera or conventional laparoscope. Task difficulty and workload demands of the surgeon and camera driver were assessed using the validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire. Surgeons were also asked to score 6 parameters on a Likert scale (range 1=low/easy to 5=high/hard): procedure-associated workload, ergonomics, technical challenge, visualization, accidental events, and instrument handling. Each step of the nephrectomy was also timed and instrument clashing was quantified. Scores for each parameter on the Likert scale were significantly lower for MAGS-LESS nephrectomy. Mean number of internal and external clashes were significantly lower for the MAGS camera (p<0.001). Mean task times for each procedure were shorter for experts than for novices, but this was not statistically significant. NASA-TLX workload ratings by the surgeon and camera driver showed that MAGS resulted in a significantly lower workload than the conventional laparoscope during LESS nephrectomy (p<0.05). The use of the MAGS camera during LESS nephrectomy lowers the task workload for both the surgeon and camera driver when compared to conventional laparoscope use. Subjectively, it appears to also improve surgeons' impressions of ergonomics and technical challenge. Pending approval for clinical use, further evaluation in the clinical setting is warranted.

778 IS THERE A PERIOPERATIVE ADVANTAGE TO ROBOTIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY VERSUS CONVENTIONAL LESS PYELOPLASTY?

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011778 IS THERE A PERIOPERATIVE ADVANTAGE TO ROBOTIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY VERSUS CONVENTIONAL LESS PYELOPLASTY? Ephrem Olweny, Sara Best, and Jeffrey Cadeddu Ephrem OlwenyEphrem Olweny Dallas, TX More articles by this author , Sara BestSara Best Dallas, TX More articles by this author , and Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1817AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site surgery (LESS) continues to gain enthusiasm in urology, but is technically challenging owing to instrument clashing, loss of instrument triangulation, and difficulty sewing. Application of the da Vinci Si™ robotic surgical system to LESS (R-LESS) may help overcome these challenges. We describe our initial experience with R-LESS pyeloplasty, and compare perioperative outcomes to conventional LESS pyeloplasty. METHODS Between May and October, 2010, 5 patients underwent R-LESS pyeloplasty at our institution. Outcomes were compared to those for the 10 most recent patients who underwent conventional LESS pyeloplasty. Surgical indication in all cases was relief of symptoms. LESS pyeloplasty was performed using 3 5-mm trocars (4/10), or the GelPOINT™ platform (Applied Medical, Rancho Santa Margarita, CA) (6/10), through a single 3-cm umbilical incision. A lateral 3-mm instrument was necessary to facilitate triangulation for the anastomosis. Antegrade JJ stent insertion was performed. R-LESS pyeloplasty was performed using the robotic instruments, camera, and a 5-mm assist port through a GelPOINT™ platform. Retrograde JJ stent insertion was performed. For all right-sided R-LESS and LESS cases, a 3-mm liver retractor was inserted through a separate stab incision. RESULTS For R-LESS vs. LESS respectively, there were no significant differences in age, gender distribution, BMI, proportion with prior abdominal surgery, estimated blood loss (56 vs. 42 ml; p=0.55), or hospital length of stay (2.3 vs. 2.6 days; p=0.60). Mean operative time was longer for R-LESS (228.2 vs. 188.3 min; p=0.02). Subjectively, there was significantly less instrument clashing with R-LESS, and the anastomosis could be completed without the need for an additional lateral instrument. There were no intra- or perioperative complications in the R-LESS group, while 2 conversions to conventional laparoscopy, and 2 Clavien Grade 3b postoperative complications occurred in the LESS group. CONCLUSIONS Initial experience with R-LESS pyeloplasty is favorable, with improved ergonomics (particularly the anastomosis), fewer complications, and equivalent perioperative outcomes to conventional LESS pyeloplasty. Operative times were modestly longer, likely attributable to the additional step of cystoscopy and JJ stent placement. Further improvements in technique with development of robotic systems specific to R-LESS are anticipated. Short and long-term functional outcome data are pending. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e313 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ephrem Olweny Dallas, TX More articles by this author Sara Best Dallas, TX More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

768 UROLOGIC LAPAROENDOSCOPIC SINGLE SITE SURGERIES USING HOMEMADE SINGLE PORT DEVICE: A SINGLE CENTER EXPERIENCE OF 200 CONSECUTIVE CASES

INTRODUCTION AND OBJECTIVES: With advancements in laparoscopic instruments, consideration of cosmesis and trends for minimal invasiveness, the number of laparoendoscopic single site surgery (LESS) has been performed for diverse urologic diseases. We report our experience with 200 patients who underwent LESS surgery using a homemade single port device in a single institution. METHODS: Between December 2008 to October 2010, 200 consecutive LESS urologic operations were done in Shinchon Severance hospital. Conventional LESS (C-LESS) and robotic LESS (RLESS; da Vinci S, Intuitive Surgical, USA) procedures were performed by three expert laparoscopic surgeons. All procedures were done using a homemade single port device with size 7 non-powdered surgical gloves and the Alexis¢c wound retractor which was inserted through a 2 to 4cm umbilical incision. The port device was made by placing gloves to the retractor outer ring by suturing and repeated folding to prevent air leak. A homemade single port was established by inserting three or four 12-mm and 8-mm trocars through the fingers of a surgical gloves and securing it to the port with rubber band. In R-LESS, an additional trocar was inserted in the midline below the subxiphoid process or alongside the homemade single port to establish a 12-mm hybrid port if needed. RESULTS: Of the 200 patients, 111 underwent C-LESS and 89 underwent R-LESS. Mean patient age was 53 years, mean operative time was 190.9 minutes, and mean estimated blood loss was 204 mL. Intraoperative complications occurred in seven cases (3.5%), and postoperative complications in nine cases (4.5%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification). Conversion to mini-incision open surgery occurred in eight (4%) cases. Regarding oncologic outcomes, there were five cases of distant metastasis in total 101 cases of cancer operation including aggressive progression of Ewing sarcoma and leiomyosarcoma. Two bladder recurrence was occurred in nephroureterectomy cases. Operative records, pathologic results and complication data are described in Table 1. CONCLUSIONS: LESS is technically feasible and safe for various urologic diseases. However, surgical experience and long-term follow-up are needed to test the superiority of LESS.

Robotic natural orifice translumenal endoscopic surgery and laparoendoscopic single-site surgery: current status

To analyse the evidence supporting current and future application of robotic technology in natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). Early clinical experience with the application of currently available da Vinci robotic system to LESS has been encouraging, as some of the constraints encountered during conventional LESS can be overcome. Robotic devices that are currently being developed for NOTES and LESS focus on improving either tissue manipulation capabilities for externally actuated robotic and flexible endoscopy systems or visualization for robots that are inserted completely into the peritoneal cavity. Robotic technology is rapidly evolving and is expected to drive several aspects of minimally invasive surgery forward in the near future with the ultimate goal of minimizing complications and improving outcomes.

Initial experience with 50 laparoendoscopic single site surgeries using a homemade, single port device at a single center

Purpose: We report our technique of and initial experience with 50 patients who underwent laparoendoscopic single site surgery using a homemade single port device at a single institution. Materials and Methods: Between December 2008 and August 2009 we performed 50 laparoendoscopic single site surgeries using the Alexis wound retractor, which was inserted at the umbilical incision. A homemade single port device was made by fixing a size 7 1/2 surgical glove to the retractor outer ring and securing the glove fingers to the end of 3 or 4 trocars with a tie and a rubber band. A prospective study was performed in 50 patients to evaluate outcomes. Results: Of 50 patients 34 underwent conventional laparoendoscopic single site surgery, including radical and simple nephrectomy, and cyst decortication in 8 each, nephroureterectomy in 3, partial nephrectomy and adrenalectomy in 2 each, and partial cystectomy, ureterectomy and ureterolithotomy in 1 each, while 16 underwent robotic laparoendoscopic single site surgery, including partial nephrectomy in 11, nephroureterectomy in 3, and simple and radical nephrectomy in 1 each. Mean patient age was 52 years, mean body mass index was 23.4 kg/m(2), mean operative time was 201 minutes and mean estimated blood loss was 201 ml. Four intraoperative complications occurred, including 2 bowel serosal tears, diaphragm partial tearing and conversion to open radical nephrectomy. One case of postoperative bleeding was managed by transfusion. Surgical margins were negative in the 13 patients who underwent partial nephrectomy. Mean hospital stay was 4.5 days (range 1 to 16). Conclusions: Our homemade single port device is cost-effective, provides adequate range of motion and is more flexible in port placement for laparoendoscopic single site surgery than the current multichannel port.

Initial Experience With 50 Laparoendoscopic Single Site Surgeries Using a Homemade, Single Port Device at a Single Center

We report our technique of and initial experience with 50 patients who underwent laparoendoscopic single site surgery using a homemade single port device at a single institution. Between December 2008 and August 2009 we performed 50 laparoendoscopic single site surgeries using the Alexis wound retractor, which was inserted at the umbilical incision. A homemade single port device was made by fixing a size 7 1/2 surgical glove to the retractor outer ring and securing the glove fingers to the end of 3 or 4 trocars with a tie and a rubber band. A prospective study was performed in 50 patients to evaluate outcomes. Of 50 patients 34 underwent conventional laparoendoscopic single site surgery, including radical and simple nephrectomy, and cyst decortication in 8 each, nephroureterectomy in 3, partial nephrectomy and adrenalectomy in 2 each, and partial cystectomy, ureterectomy and ureterolithotomy in 1 each, while 16 underwent robotic laparoendoscopic single site surgery, including partial nephrectomy in 11, nephroureterectomy in 3, and simple and radical nephrectomy in 1 each. Mean patient age was 52 years, mean body mass index was 23.4 kg/m(2), mean operative time was 201 minutes and mean estimated blood loss was 201 ml. Four intraoperative complications occurred, including 2 bowel serosal tears, diaphragm partial tearing and conversion to open radical nephrectomy. One case of postoperative bleeding was managed by transfusion. Surgical margins were negative in the 13 patients who underwent partial nephrectomy. Mean hospital stay was 4.5 days (range 1 to 16). Our homemade single port device is cost-effective, provides adequate range of motion and is more flexible in port placement for laparoendoscopic single site surgery than the current multichannel port.